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Fever is one of the most common problems in pediatrics, and can be very frightening to parents. Although many people consider a normal body temperature to be around 98.6° F, the truth is a child’s body temperature goes up and down all day long, and what is “normal” is different for every child. Pediatricians consider a fever to be a body temperature of 100.4° F.

A rectal temperature is the most accurate way to check for fever in an infant. Temperatures taken under the arm or under the tongue in older children are usually accurate, but can be off by as much as one degree even when done correctly. There is no rule to automatically add or subtract a degree from your thermometer’s reading, however, no matter what method is used.

Although fever has many causes, infection is the most common. Most infections in children are caused by viruses which are, in most cases, not dangerous. Fever itself is just a symptom and rarely causes any problems (it does not cause brain damage no matter how high it gets), however the cause of the fever (the infection itself) sometimes can. We tend to worry more about children with body temperature greater than 102° F or children with fever that doesn’t respond to medication, although any ill-appearing child or any child with multiple or prolonged symptoms should be seen by a doctor.

Contact your pediatrician immediately if your child has fever and:

  • Is less than 3 months old
  • Appears ill (drowsy, severe headache, not acting like herself/strange behavior)
  • Continues to appear ill even after the fever has dropped
  • Isn’t drinking
  • Has a chronic or underlying medical problem (ie sickle-cell disease, immune system problem)
  • Has had recent travel outside the country
  • An odd-looking or rapidly appearing rash
  • Has a seizure
  • The fever hasn’t improved after 3 day

Some children have seizures if they have a high fever. This is not uncommon and in most cases not harmful (although very scary for a parent), but your pediatrician needs to know about this immediately if it occurs.

Two popular medications used to treat fever are ibuprofen (Motrin®, Advil®) and acetaminophen (Tylenol®), although ibuprofen can only be used in children older than 6 months old. Ibuprofen can be given every 8 hours, and acetaminophen can be given every 4 hours. We recommend alternating ibuprofen and acetaminophen every 4 hours as needed to control fever. Do not use any medicine if the child has no fever, and be careful not to exceed the recommended dosage, because over-treating a fever can be more dangerous to your child than the fever itself. Make sure your cold medicine doesn’t already have ibuprofen or acetaminophen in it. NEVER use aspirin in a child.

A lukewarm sponge-bath may also help bring a fever down. A cold bath, however, can actual drive the body’s temperature higher, so avoid this practice.

If your child’s fever has not come down within 30 minutes after giving ibuprofen and trying a tepid bath, contact your pediatrician (someone is always on call, even in the middle of the night).

In general, a mild fever in a child over 3 months of age who seems well rarely requires treatment. If you are ever unsure of how serious your child’s condition is, however, contact your pediatrician.